RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00185
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Trans Operator/maintainer, medically separated for “chronic pain, left shoulder,” with a disability rating of 0%.

CI CONTENTION:  The CI contends several conditions were not evaluated or considered.  Additionally, the evaluated percentages were inaccurate and unfair.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20060614	VARD - 20060807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	0%	Left Shoulder Rotator Cuff Syndrome with Left Trapezius Tendonitis	5024-5201	20%	20060630	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Shoulder (Dominant).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left-handed CI’s left shoulder condition began in April 2004 after loading and unloading heavy equipment, with no specific injury or trauma.  Imaging studies in November 2005 showed supraspinatus tendon degeneration or a tiny partial thickness tear.  There was no surgical indication, and conservative treatment including activity modification, physical therapy (PT), medications, and steroid injections, did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left shoulder pain” for PEB adjudication.

Examinations in November and December 2005 showed “full range of motion” of the left shoulder; however, on 25 January 2006 (6 months prior to separation), the CI re-injured his left shoulder while performing push-ups.  At that time he described experiencing an acute “pop” in his left shoulder with associated numbness and tingling of the shoulder and arm.  Repeat imaging studies (MRI arthrogram) on 7 February 2006 reportedly showed rotator cuff tendon fraying.  Left shoulder range of motion (ROM) was noted to be significantly impaired for approximately 2-3 months after this re-injury.  Flexion during that time ranged between 80 – 110 degrees (normal 180) and abduction between 45 – 90 degrees (normal 180); however, with time and PT left shoulder ROM improved considerably.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 27 April 2006, 4 months prior to separation, the CI reported left shoulder pain that was constant, sharp, throbbing and associated with intermittent numbness and tingling down the arm when overused.  Pain was aggravated by overhead activities, lifting and pushing movements.  Physical examination showed limited motion.  There was no tenderness and no swelling, and normal sensation with 3/5 motor strength.  A PT examination on 9 May 2006 found left shoulder flexion of 110 degrees and abduction of 135 degrees.

The MEB NARSUM examination on 19 May 2006 (2 months prior to separation) noted complaints of persistent left shoulder pain which was aggravated by running, high impact activities, lifting and wearing military equipment.  Physical examination showed tenderness of the superior aspect of the left shoulder.   Painful motion was present.  Muscle strength testing was limited due to pain, but sensation and reflexes were intact; and muscle atrophy was not present.  Left shoulder abduction was 140 degrees; active ROM was indicated as otherwise “normal” although specific measurement of flexion was not provided.  

At a PT follow-up examination on 5 June 2006 (1 month prior to separation), left shoulder flexion was 140 degrees and abduction was 135 degrees.  At the orthopedic clinic appointment on 13 June 2006, 1 month prior to separation, the CI reported left shoulder pain of 7/10 severity.  Narcotic medication was “somewhat helpful” for pain.  Symptoms associated with a history of shoulder dislocation were denied.  Examination showed no atrophy, but tenderness was present.  Abduction and flexion were 130 degrees each, and painful motion was noted between 80 and 130 degrees.  Shoulder tenderness was present and there was no muscle atrophy.

At the 30 June 2006 VA Compensation and Pension (C&P) evaluation, performed 2 weeks before separation, the CI reported problems with pushing, pulling, and overhead work.  Left shoulder flexion was 140 degrees and abduction was 80 degrees.  Painful motion was only present at the end of abduction and external rotation.  The CI was not willing to perform repetitive motion due to pain; however, informal observation did not support the presence of additional limitation with repetition.  Neurologic examination was normal.  At an emergency room visit on 25 September 2006 (3 months after separation) for evaluation of low back pain, the CI stated that his left shoulder pain was “not bothering him right now.”  Examination showed “full ROM” of the left shoulder with “min [minimal] discomfort.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left shoulder condition 20% coded 5024-5201 (tenosynovitis; arm, limitation of motion of), based on the VA C&P examination 2 weeks before separation, citing limitation of abduction at 80 degrees as the rationale.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side).  The Board agreed that the ROMs reported during the 2-3 month period after re-injury in January 2006 did not reflect a healed, stable state; therefore, those reports held no probative value in the Board’s deliberations.  The limitation of shoulder motion reported at the VA C&P examination supported a 20% rating based on the limitation of abduction to 80 degrees; however, all other examinations proximate to the time of separation (including an emergency room assessment which was 3 months after separation and the C&P exam) showed abduction above shoulder level.  The Board concluded a 20% rating for limitation of shoulder motion was not warranted; however, there was considerable evidence to support application of VASRD §4.59 (painful motion) as a pathway to a 10% rating.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left shoulder condition, coded 5201-5003.

BOARD FINDINGS:  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Shoulder 	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002550 (PD201500185)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA